Xavier University of Louisiana

XAVIER UNIVERSITY OF LOUISIANA

New Orleans, Louisiana 70125

SOLE SOURCE FORM

Date:
Requisitioning Department & REQ#:
FOPAL Number:
Authorized Initiator:
Type of Materials, Supplies and/or Equipment:

Justification for Sole Source:

1) If purchase related to compatibility with existing equipment, then identify the item(s) and applicable tag number.

2) Sole Source Considerations (Place a check next to the one that best applies)

A) Exclusive Rights…Item under patent secret process or copyright held by a single

vendor and item possesses functions, secret process or capabilities critical to use.

B) Propriety Design…Item possesses a unique function or capacity

critical in the use of the item and not available from any other.

C) Replacement Equipment…The purchase is for equipment

associated with use of the existing equipment where compatibility

is essential for integrity of results essential.

D) Replacement Parts…The purchase is for replacement parts in support of equipment specifically

E) Replacement Accessories…The purchase is for accessories sought for

enhancement of existing equipment where compatibility with equipment from the

original manufacturer is paramount.

F) Technical Service…The purchase is for technical services associated with the

assembly, installation or servicing of equipment of a highly technical or

specialized nature.

G) Continuation or Prior Work…Additional item, service or work required but not

known to have been needed when the original order was placed with vendor or construction

contractor (need original purchase order number).

SOLE SOURCE FORM

H) Exclusive Capability…Only one vendor qualified (no other potential vendors known).

I) Other…Provide details.

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3) Replacement Equipment, Parts or Accessories (Mark The One That Best Qualifies)

A) The item is manufactured or produced by the supplier and the supplier solely distributes

(sells) direct to the customer.

B) The item is produced by the manufacturer, but not sold directly to the customer by the

manufacturer, and the manufacturer solely distributes the item through a single supplier

in the world, United States, region, Louisiana or identified market area.

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Procurement Specialist Initiator